A proposed compromise on “Obamacare”

As per usual, the hacks we have in Washington who’ve been bought and sold by the various forces in health care in this country (none of us that actually struggle with paying for health insurance or health care) have only two positions on a national health insurance initiative- yes or no.

I’m not a fan of “Health Insurance” at all- but, that’s just not going to happen- there are too many jobs in the “health insurance” industry to try to convert them to actual health care providers fast enough.

To me, health insurance is nothing different than the Mafia telling a business “pay us for protection- or we’ll hurt you.” At a cost of about 35% added overhead to an already out of control health care delivery system.

While Republicans are all against mandatory health insurance, they are also big on free market enterprise, and that’s why I hope this compromise is attractive to them.

Require all institutions that accept medicaid or medicare or federal research dollars to comply with a maximum of 40/1 compensation structure for all employees if over 51% of their payroll is in the USA (if they offshore services to more than 51% of their employees- less likely in health care but more likely in health insurance, the maximum compensation rate is 20/1 average payroll)

Create a pricing transparency system- where all rates charged to insurance companies (including Medicare and Medicaid) are posted online and the average price of any service to the insurance companies will be the market price to those paying with cash.

It’s time we started to address one of the hardest to manage expenses for small business and one of the leading causes of bankruptcy in this country- ridiculous health insurance and health care costs and outlandish premiums.

It’s real options like this that motivate me to run for Congress and I hope I have your support.

If you have any ideas to improve this option, I’d love to hear them.

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In the first place, calling it “Obamacare” is kind of like calling Afghanistan “Obama’s war.” The health care reforms that have been passed (but not yet implemented fully) are seriously altered from Obama’s original proposal. Where, for example, is the public option?

Secondly, health care is a segment that Adam Smith would have concluded is not ruled by free market forces. Health care is not goods or services that a reasonable consumer may choose to do without. It is not a perfectly competitive marketplace where providers must compete. When you’re sick or injured, you have little time or incentive to comparison shop.

We already know that nations with a single-payer system spend about half what the U.S. does on health care while getting better results. The stubborn refusal to even consider going to such a system proves that, to a lot of U.S. policymakers, whether something works is less important than whether it pays.

So, David, I don’t know that your proposals would work. I will note that one provision of the current health care reforms–the one that says that insurers must pay out 80-85% of premiums to cover the insureds’ health care cost, or issue refunds–ought to have the effect of reducing greedy CEOs’ gross pay.

It may reek of sensibility, but cheering or condemning “Obamacare” is premature; reasonable people might want to wait until it’s been running a couple of years before assessing success or failure.

One of the most morally perplexing issues with controlling spiraling health care costs is how do we deal with end-of-life care. A HUGE percent of Medicare dollars (I forget the %) is spent within the last 3 months of life…trying to prolong life. Not to be too morbid, but it’s worth reading this piece on how doctors die:

Years ago, Charlie, a highly respected orthopedist and a mentor of mine, found a lump in his stomach. He had a surgeon explore the area, and the diagnosis was pancreatic cancer. This surgeon was one of the best in the country. He had even invented a new procedure for this exact cancer that could triple a patient’s five-year-survival odds — from 5 percent to 15 percent — albeit with a poor quality of life. Charlie was uninterested. He went home the next day, closed his practice, and never set foot in a hospital again. He focused on spending time with family and feeling as good as possible. Several months later, he died at home. He got no chemotherapy, radiation or surgical treatment. Medicare didn’t spend much on him.It’s not a frequent topic of discussion, but doctors die, too. And they don’t die like the rest of us. What’s unusual about them is not how much treatment they get compared to most Americans, but how little. For all the time they spend fending off the deaths of others, they tend to be fairly serene when faced with death themselves. They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care they could want. But they go gently.

…cheering or condemning “Obamacare” is premature; reasonable people might want to wait until it’s been running a couple of years before assessing success or failure. (truddick)

…name one endeavor besides defense, truddick, that government does well. And please identify one government program that has been undone after it has planted its’ bureaucratic roots. And reveal which state endeavors delivers on budget and on time. “Reasonable people” truddick? Reasonable people do not defy the will of the people, and the bulk of the democrats who pushed this legislative horror thru have been bum-rushed. Sorry truddick if we don’t wait a couple of years to undo this assault to our liberty and our pocketbooks. And that goes double for President One-and-Done…

“…name one endeavor besides defense, truddick, that government does well. ”
you’ve got to be joking. really? they’re the epitome of govt waste, just ask any veteran of the past 20 years with some sort of analytical skills.

“Reasonable people do not defy the will of the people, and the bulk of the democrats who pushed this legislative horror thru have been bum-rushed.”
Perhaps. However, “the people” elected Obama in part because of his stance and promises on healthcare. Regardless of what’s being passed and what’s not the people at large recognize that something must be done about healthcare. If democrats and supporters of healthcare reform spent half as much in support of what they assumed the people already understood about these reforms as the republicans spent on ads that created fear of government mandated healthcare then I believe the original intentions of “Obamacare” (not its current form) would be perceived differently today. (I don’t have time to find all the numbers on this… just going from what I remember seeing two years ago on TV… relentless, misguided, anti-healthcare ads)

While Republicans are all against mandatory health insurance, they are also big on free market enterprise, and that’s why I hope this compromise is attractive to them. Keep the requirement that insurance companies can’t reject anyone who applies. Require all institutions that accept medicaid or medicare or federal research dollars to comply with a maximum of 40/1 compensation structure for all employees if over 51% of their payroll is in the USA (if they offshore services to more than 51% of their employees- less likely in health care but more likely in health insurance, the maximum compensation rate is 20/1 average payroll) Create a pricing transparency system- where all rates charged to insurance companies (including Medicare and Medicaid) are posted online and the average price of any service to the insurance companies will be the market price to those paying with cash. Esrati How are more arbitrary government rules and regulations a compromise with free market principals? “health care is a segment that Adam Smith would have concluded is not ruled by free market forces.” Truddick First off, there aren’t “free market forces” and “non free market forces”. There are just market forces driven by the decisions of millions of people making millions of decisions everyday based on the information available to them. Secondly…we’ll let Adam Smith speak for himself “ That wisdom which contrived the system of human affections, as well as that of every other part of nature, seems to have judged that the interest of the great society of mankind would be best promoted by directing the principal attention of each individual to that particular portion of it, which was most within the sphere of his abilities and his understanding.” –Adam Smith Theory of Moral Sentiments In other words. No one is smart enough to efficiently manage and wants and desires of mankind….those decisions are best made by the individual. “Not to be too morbid, but it’s worth reading this piece on how doctors die: “- John Ise I don’t find individuals making decisions like this for themselves to be morbid. However, advocating that… Read more »

Oh come on folks, are we all blind to the fact government is taxing us and handing that money to corporations to distribute back while the corporations take thirty percent off the top? Our country has been outsourced. This is no longer an argument about whether government or business is more efficient – will putting insurance companies in charge of reducing health care costs really work? Tea Party and #Occupy are on the same page, it’s the corporate owned media pitting them against one another and all the fools shouting ‘the other party is evil’ while your pocket is being picked. Waaaake up!

BREAKING: 2.5M Young Adults Got Insurance from Obamacare Jonathan Cohn The economy remains weak and health insurance keeps getting more expensive, but the number of young adults without health insurance fell by 2.5 million this year. How could that be? Simple. President Obama and the Democrats passed health care reform. And, by all accounts, it’s starting to do some good. A lot of good. As Ricardo Alonso-Zaldivar of the Associated Press first reported on Wednesday, the Centers for Disease Control is releasing new data that shows the number of young adults, ages 19-25, without private insurance fell from about 10.5 million to 8 million between 2010 and the middle of 2011. The number of Americans in other age groups, including those between 26 and 35, went up in the same period. Why would adults younger than 26 be so much more fortunate than those who are older? The only possible explanation, according to administration officials and most health care experts I know, is the Affordable Care Act. One of the first provisions to take effect is a requirement that insurers offering family coverage include dependents up through the age of 25. This isn’t the first time we’ve heard about that provision having an impact: Previous estimates, public and private, had suggested at least half a million people and possibly many more had gotten health insurance thanks to the young adult provision. These latest numbers from the CDC, according to the administration, are more precise than those previous reports. (Even if subsequent analysis suggests the 2.5 million figure is high, it’s clear large numbers of young people are taking advantage of this provision.) Critics of the law, which they (and I) like to call “Obamacare,” have suggested that its expansions of and improvements to health insurance are not worthwhile because of the expense they inevitably impose. And it’s certainly true that requiring insurers to cover more services or more people will, on its own, force the insurers to raise premiums. Recent private sector estimates have suggested that the law’s new requirements have raised premiums by 1 to 2 percent. But… Read more »

I know that I have already stated this argument in other posts on this and other sites, but I think it needs to be reiterated. Talking about Adam Smith and capitalism without talking about the changes in understanding that have occurred since the 1700’s is like talking about black holes, quarks and antimatter and quoting Newton (interestingly, active only about 70 years earlier than Smith).

Please see the document for an analysis as to Smith as an advocate of the free market.

I do not have health insurance. When I need surgery, I am going to ask my buddy Jesse to cut me open and save me. And when he does (he is a pretty smart guy), I am going to sue him for saving my life without a license from the government to save my life. Then I will be healthy and rich!

Ice…I don’t know why we concede that (government can) do a “good job” with regard to our defense. Look at the spending. (Jesse)

you’ve got to be joking. really? (defense is) the epitome of govt waste…(Dan)

…of course, you are both correct. And apologies for the delayed response. But consider, for example, what a far darker planet this would be had the Axis had been able to realize their dream of global conquest during World War II. One problem is that the US does such a good job at defense, we extended our protection to western Europe and Asia. This freedom from spending on defense allowed the Europeans to devolve into hapless and hopeless nanny states, which is now rapidly becoming undone. And the US government seems obsessed with the unnecessary task of protecting Americans from their own decisions…

@Ice- there is a huge difference between our standing military now- and the one pre-Pearl Harbor. We ramped up the war machine for a real war- and sold war bonds to pay for it.

What we have now is the military contractors selling us stuff that we don’t need. Please explain the need for an F-35 when you can do the same damage with a remote controlled plane or guided missiles that cost fractions of what a single plane costs?

David wrote:
“What we have now is the military contractors selling us stuff that we don’t need. Please explain the need for an F-35 when you can do the same damage with a remote controlled plane or guided missiles that cost fractions of what a single plane costs?”

Not a good way to get elected to Congress to represent the district containing Wright Patterson Air Force base. :P

@Mark- I believe in programs that keep our troops safe- and give us real superiority. A human can’t handle the G-forces that an unmanned vehicle can. I believe true superiority isn’t provided using old thinking.

Our surface Navy is also obsolete for the most part. Yet, we continue to invest in it. There isn’t another Navy out there that can touch us- nor is there reason to have what we have. How many SEALS did it take to kill a Somali pirate? Get the picture?

Real security isn’t achieved with guns and nuclear weapons- security happens when the rest of the world doesn’t hate us. If we’d spent the trillions we just spent on Iraq and Afghanistan on international aid and raising the standards of living across the globe- we’d be better off.
Instead- we went and killed a lot of people, forced our “systems of democracy” on others- and pissed off a bunch more people who will do more damage with a dirty bomb in a briefcase than with something that can compete with our current F-16.

There is plenty to do at WPAFB inventing and supporting the modern war fighter- it’s just insane that we’re building the weapons of the last war- instead of working on preventing the next one.

@ David Esrati. I disagree with nearly everything you wrote in your previous comment. So let’s agree to disagree.

In June, 1944, my grandfather was part of the invasion of Normandy. In May, 1945, on VE-day, he was with his Army unit in Pilzen, Czechoslovakia. In August, 1945, he was back in the US on leave, with orders to head west for the upcoming invasion of Japan. He was quite happy to have those orders cancelled after Japan surrendered after the bombs were dropped. I know that he, along with many others including me, disagree with your point that “Real security isn’t achieved with guns and nuclear weapons”.

Not sure what your point is about the US Navy and Somali pirates.

I most disagree with your points that the best method of national defense is to ensure that other people don’t hate us, and that we should replace defense spending by attempting to buy our way into other people’s favor. There have been and still are a lot of bad guys out there, and we aren’t going to protect ourselves by trying to pay them off.

@Mark- as a former solider who was trained to train others, and to win hearts and minds over to our way of thinking, I can categorically tell you that you win with open hands and hearts more than muscle and fear.

There have been many scholars who have decidedly come to the conclusion that the 2nd atom bomb didn’t need to be dropped- and others who consider it a war crime. Atomic bombs don’t make any winners- and are an environmental nightmare. The “mutually assured destruction” dogma of the fifties- is still as stupid as it was then. No one wins when we all die.

The point of the Navy- and Somali pirates, is there is never going to be another huge naval battle like Midway. Those days are over- yet, we still have a huge surface fleet and aircraft carriers built to launch manned aircraft. Change to a sub-surface navy- as proposed in the early eighties by Gary Hart was proven by the performance of a cheap Exocet missile taking out a British warship. The reality of naval warfare changes when you realize anything bigger than a low-cost speedboat- is just bait.

Considering we’ve had to fight people who’ve bought our weapons- maybe if we stopped arming the world, it would be much easier to maintain superiority. However, the reality is the most dangerous threat to foreign sovereign nations is no longer a B-52 carrying nukes- but the people at Standard and Poors, Moodys and Fitch- rating their economies.

It’s time for the hawks to wake up and smell the roses. In the end- money wins over guns. The fact that China could crash the entire US economy without firing a single shot should be first and foremost on any true thinking when it comes to “national defense.”

David: Once again, I disagree with nearly everything in your post about national defense.

Your comment about “winning hearts and minds” of people in other countries is an expression which was used a lot years ago.

That phrase always reminds me of the saying I heard when I was a soldier:

“When you have ’em by the balls, their hearts and minds will follow.” :P

(Incidentally, I started coming to your blog when it appeared in search results about the workings of Montgomery County government. The information you have posted about how things work, how jobs get filled, the nepotism, etc., have given me a more complete picture of county government. So thanks for your site and for hosting this forum.)

. President Obama and the Democrats passed health care reform. And, by all accounts, it’s starting to do some good.
A lot of good. (John Ise)

…well John, that example reminds the Old Bandito of the old maid accountant who embezzled big bucks from her employer. Much of the purloined dollars went to the local parish, which probably helped fund a number of local charities, so the narrative from the old gal’s defenders was “yeah, the money was stolen, but didn’t it do a lot of good?” This logic didn’t impress the local prosecutor nor the judge, not to mention the pissed-off and recently bankrupted former employer. And the media covering the incident just flat-forgot the company’s employees who were now jobless due to the cpa’s legerdemain (bad pun intended). Yessir John, taking money from the unwilling and giving it to others may, either incidentally or accidentally, do some good. But the forgotten in your narrative, like the employer and his job-seeking former employees, is that it may also do a lotta’ bad…

“When you have ‘em by the balls, their hearts and minds will follow.” (Mark)

…the Old Bandito’s first sergeant in Vietnam, where the hearts and minds bromide was really popular, had a similar saying. However, he replaced the popular term for testicles with the words “short and curlies.” This may have been due to an adverse sentiment regarding the grabbing of an adversaries’ family jewels. And then again, perhaps not…

Problem with “Obamacare”? Nothing really. The more you know, the better it is. A list of the deliverables: 1) GRANDMA WILL GET BETTER BENEFITS- The Affordable Care Act (ACA) protects Medicare for current seniors and strengthens it for future generations by focusing on the provision of free preventative care, reducing medication costs, and cracking down on waste, fraud and abuse, ending handouts to insurance, medical device and pharmaceutical companies. 2) SAVING SENIORS MILLIONS – Hundreds of thoursands of seniors have benefited from the prescription coverage gap discount this year, saving nearly $52 million. Seniors will receive bigger discounts in the years ahead. By 2020, the so-called ‘donut hole’ coverage gap in prescription medicine costs will be closed completely. 3) COVERAGE FOR YOUNG ADULTS– Thanks to the Affordable Care Act, 2.5 million more young adults (under 26) have health insurance coverage in 2011. 4) A POUND OF CURE – Nationwide, 24 million people – or approximately half of those who have traditional Medicare – have taken advantage of free preventative health benefits, including an annual evaluation, and/or other free screening services, such as mammography, colonoscopy, and immunizations. 5) FOLLOW THE MONEY- Through 2011, the Prevention and Public Health Fund has already provided a total of millions to support the critical work of State and local health departments. 6) CUTS WASTE, FRAUD, AND ABUSE – It will be much harder to bilk Medicare and Medicaid. In a sweeping effort to restore accountability, the Affordable Care Act returned $5.6 billion back to Medicare by cutting waste, fraud and abuse. 7) YOUR CHILD’S ASTHMA WON’T GET HER KICKED OFF YOUR INSURANCE PLAN – The Affordable Care Act protects millions of children with pre-existing conditions right now. In 2014, under the ACA, NO person can be denied insurance coverage for pre-existing medical conditions, and they will pay the same premiums as those without such conditions. 8) JOBS, JOBS, JOBS- Within one year of the passage of the Affordable Care Act, 1.4 million jobs have been created. 235,000 of those jobs are in healthcare, a growth sector 9) THE AMERICAN SPIRIT OF SERVICE – The ACA strengthens a longtime program that allows medical graduates to get up to $175,000 in loans paid off in… Read more »